MENTAL FINESSE

Capping the spend on mental healthcare

Given the prevalence of absenteeism resulting from mental illness, its impact on productivity and cost to the country in terms of GDP, mental health professionals and experts agree that mental health needs to become a healthcare priority and receive a bigger slice of the healthcare budget.

“Because the mortality rate from mental illness is much lower than that of HIV/Aids, mental health is not receiving the attention it deserves. If South Africa wants to alleviate its overall healthcare burden, mental health needs to be on the front burner,” says Akeso Clinics Group CEO, Allan Sweidan.

According to Sweidan, mental healthcare has the biggest influence on workday losses in a population, negatively impacting on productivity.

Some believe mental illness is self-inflicted and that sufferers should be able to cure themselves. “And that’s not the case at all. Mental illness results from a variety of causes, in the same way that all other illnesses emanate from a variety of causes,” says Sweidan.

In the meantime, South Africa’s mental health problem is increasing, impacting on the entire population and economy. Spending less on mental healthcare than on life-threatening conditions is short sighted as it will increase the overall healthcare burden, he says.

To address South Africa’s mental health dilemma, a mental health policy framework and strategic plan 2014-2020 was put in place. According to the document, the indirect cost of mental disorders outweighs direct treatment cost by two to six times in developed countries and may be even higher in developing countries.

In the first nationally representative survey of mental disorders in SA, lost earnings among adults with severe mental illness during the previous 12 months amounted to R28.2bn. This represented 2.2% of GDP in 2002, and far outweighs the direct spending on mental healthcare costs for adults (of approximately R472m). In short, it costs South Africa more to not treat mental illness than to treat it,” stated the report.

Dr Annatjie van der Wath, lecturer in psychiatric nursing at the University of Pretoria, says the Mental Health Summit at the end of 2012 highlighted the problems besetting the industry, including, among others, the lack of funding and resources, plus enormous inequity between provinces in the distribution of mental health services and resources, and the integration of mental health into primary healthcare.

A World Health Organisation (WHO) report pointed out that mental health disorders are high all over the world, with approximately 76-80% of people in low and middle income countries receiving little or no treatment, Van der Wath adds.

Fatima Sadat, resource centre manager at the SA Federation for Mental Health (SAFMH), says if you compare the high prevalence of people living with mental Illnesses with the amount of resources allocated to mental health, there is a huge gap. “Only 4% of the national health budget is allocated to mental health. However, mental health needs far more resources - the WHO predicts that by 2020, depression will most likely be the second leading cause of disability globally.

Exacerbating the problem is the shortage of mental health professionals, particularly in the public sector. According to a report on the state of psychiatry in South Africa, in 2010 there were only some 485 psychiatrists in South Africa of whom 316 were in the private sector (only 243 full time and 73 part time), and just 169 full time in the public sector. These mental health professionals are disproportionately located in urban areas while public sector mental health services are concentrated in psychiatric hospitals.

However, as the psychiatric burden of disease has grown, the private sector has managed to retain and attract high-calibre professionals. “Psychiatrists in SA are well trained, have decent private facilities in which to admit their patients, and have access to very good medication, so there’s no real reason for them to leave and seek greener pastures,” says Sweidan.

In a recent article in the Sunday Times, Akeso Kenilworth Clinic was quoted as costing R2 700 per night. Says Sweidan, “It’s all very well to say it costs R2 700 a night at a private clinic, but it’s completely a-contextual as there is a lack of understanding of what it costs to treat a patient in the public sector. In addition, there is currently no agreed understanding of what constitutes quality care and good outcomes. We should really only compare costs of the private vs public hospitals, especially in psychiatry, when we are clear about exactly what it is we are costing. Then we can have reasonable discussions about whether private sector care is expensive or not.”

According to Melvyn Freedman, head of non-communicable diseases at National Department of Health, one of the biggest issues facing the public sector in its attempts to retain doctors, is the difference between what psychiatrists earn in the public and private sectors.

While not being a psychiatrist himself, Sweidan proposes that the amounts earned by psychiatrists in the private sector quoted in the recent Sunday Times article are unchecked. “Having heard many stories from psychiatrists who have elected to leave the public sector, I would put forward the theory that earnings play a more minor role in the larger equation,” says Sweidan.